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What About Stem Cells?

January 29, 2018

• Just injecting stem cells is not a complete procedure.
• Stem cell availability has increased with placental and umbilical cord blood sources.
• Proper chemical and hormone balance can get things on the right track for healing. When balance is not optimal, it is not worthwhile to go into the doctor’s office, receive a shoulder injection, and expect miracles.
• Patients do not come to my office and just get an injection. They get balanced.
• The location of the injection, the solution to be injected, and what additional agents that can be included with the stem cells during the procedure and recovery also play a major part.
• Good judgment comes from experience.

 

One area of antiaging has to do with body parts that wear out. This happens from injury, athletics, and daily wear and tear. Joints can be repaired or replaced. One of the repairs may be stem cells.

With my career change and move to New York City there has been significant experience in the field of stem cells. This started over seven years ago with some retired NFL and NBA players. These players were going to Denver for stem cell injections of joints. The doctor there asked me to do prolotherapy injections on each patient several times to get the environment of the joint ready for healing prior to their stem cell injection. So I’m sitting there in front of a 320 pound former defensive player thinking about that involuntary knee reflex before administering the injection. And these big guys shaking in front of a little tiny needle and I have to tell them to “be a man.”

First, to harvest stem cells there is a separate procedure where bone marrow is drawn from the hip bone. To process and concentrate the stem cells takes several hours. The specimen can then be injected later the same day back into the patient.

Because of FDA regulations, stem cells cultured from the sample are considered a processed or manufactured medication which has not been authorized for use in the USA. Patients will travel to the Caribbean or other countries to receive these cultured cells by injection, which provides a higher concentration of stem cells. Are there differences in results with groups receiving cultured or non-cultured stem cells? Is there a minimal number of stem cells that correlate with the level of the result?
Another source of stem cells is adipose tissue which also requires a separate procedure to liposuction the fat as the source of the tissue.

Amniotic fluid stem cells then became available. One of the benefits is to save the patient an additional procedure for harvesting stem cells. The other thing to consider is what is the shape of stem cells that come from someone who is medically not very healthy? And older? Here is a better source.

Amniotic fluid stem cells are harvested from patients scheduled for a C-section. Donors are 18 to 35 years old and undergo extreme medical clearance. The fluid is donated at the time of the C-section. These little cells are pluripotential– in other words, they can do anything. This has been shown with clinical experience.

Besides amniotic fluid there is another embryonic type stem cell that can be obtained from placental cord blood. These cells are also pluripotential-versatile ball players. The specimen is obtained from a scheduled C-section on medically qualified donors. This also does not require a separate procedure for harvesting stem cells from the patient. The cells have been filtered so there is no HLA, which is a protein that can cause an incompatibility reaction.

The last two sources of stem cells can be used universally and saves the patient from having a painful second procedure for harvesting.
Speaking with colleagues across the country about their experience with one type of case or another, these cells cannot and have not caused any allergic or incompatibility reaction. Over the years none of us has seen any adverse side effects. So, very safe with good results.
The list of medical conditions being treated seems unlimited.

Now some important points:

First, some of the retired professional players did better than others. This correlated very closely with chemical and hormone balance. Some were in a physical shape where the body was not ready to heal anything. Patients in a degenerative, aging process and poor overall health may not have optimum results. Besides slow deterioration, chronic inflammation may not cause any acute pain or symptoms.
These guys were giving their own stem cells from hip bone marrow. How good was it? Stem cell source is important and there are many advantages of amniotic and placental blood sources. Their availability is extremely valuable.

Second, consider where to inject. Intra-articular and soft-tissue results are straightforward. It is useful for Achilles and large tendon tears to prevent rupture. This can be used to repair partial tendon ruptures, even with an intra-articular injection.
Injections for different types of facial pain and migraine headaches have greater than 70% success rate for long-term good relief and over 90% with some definite benefit. The injection for these is in the face and skull.

Third, what else can be administered along with the stem cells? For instance, hyaluronic acid promotes restructuring of nervous tissue, particularly the nerve sheath or the insulation covering the nerve. This can be used when dealing with chronic nerve pain. Mixing stem cells with hyaluronic acid can help lengthen the duration of dermal fillers. And this is all natural tissue.

This is not just inject stem cells and all is good. Here is a reasonable approach about stem cell treatment:
1. What is the attempt to heal or repair? Judgment needs to be used because sometimes the injury is such that a surgical procedure is necessary. An injection alone would not be sufficient.
2. Look at the overall chemical and hormone balance of the patient. Borderline diabetic or elevated ferritin (indicating liver inflammation) levels can certainly affect results. This is like being a coach, training patients and getting the human machine ready for healing. Sometimes a short recovery course of growth hormone can get things started off well.
3. Where is the injection located? Intra-articular is easy enough. A sphenopalatine ganglion block in the head can be very useful as a location to inject in the relief of many painful facial symptoms. Pain specialists frequently perform sympathetic denervation (disconnection) on the stellate ganglion to try to affect the overall autonomic nervous system. Stem cells will go for repair. Looking at something long-term and possibly permanent, location can be very important as far as the result.
4. As a surgeon with over 40 years operating on every part of the body, I feel widespread background and experience in medicine offers additional benefit. We are looking at dealing with an entire human machine.
5. There is no current textbook with study proven recipes for stem cell administration. Judgment and experience is necessary. What can be added to an injection solution to help support the stem cells can be instrumental to promote a good result. This may include hyperbaric oxygen treatments, growth hormone injections, hyaluronic acid, and low doses of bio identical hydrocortisone. A little bit of glucose helps ignite the insulin receptors on cell membranes. This can provide an entry for the stem cells across the blood brain barrier. Now make a list such as Parkinson’s, post stroke pathology, and the potential for treatment of other intracranial chronic diseases. Good judgment comes from experience.
6. Stem cells can be given intravenously for lung problems. Following the circulation from the intravenous administrative site in an arm, the blood first passes through the right side of the heart. The next path is through the lungs. The lung filters the blood at the alveolar capillary level. Then blood collects and goes back to the heart which pumps it out to the body. After leaving the heart many stem cells become sequestered in the spleen so their numbers diminish. But the first pass through the lungs makes this organ an easy target.
7. Chronic inflammation will stimulate stem cell activity. Severe and chronic inflammation serve as a focus and can attract stem cells. The inflammatory process produces a chemical called tumor necrosis factor (TNF). This is the real killer that causes problems with chronic inflammation. There are drugs that can block this effect. When this is given at the time of the injection it can increase the efficacy of the treatment.
8. There is a lot of controversy on systemic administration of stem cells. There is no definite recipe that identifies specific routine measures that can be done to attract stem cells to areas of chronic inflammation for initiating their repair activity.
9. Administration of stem cells has no significant risk and can be administered conveniently.
10. The big cost is the pocketbook. Stem cell injections for one joint may be in the range of $4000-$5000 in New York City for a treatment. This may be as high as $8-10,000 in California. I reemphasize, just injecting stem cells is not a complete procedure.

 

Let me know any questions. One aspect of antiaging has to deal with parts that wear out. The patient can decide whether to promote as good of healing as possible or go in and have a joint replacement. Insurance policies cover joint surgery. You decide the best option for you. I try to lay it out on the table for patients to understand and to help them make a comfortable and personal decision. Stem cells and the method with which they are administered can lead to impressive results, prevent surgery, and disable and repair some chronic processes.

 

Posted in Blog by jbosiljevac

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